This division is one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation.
Responsible for the administration of medical management services for company health plans and ensures clinical integrity of broad and significant clinical programs, including the overall medical policies of the Medicare business unit.
Primary duties may include, but are not limited to:
- Evaluates requests for service coverage for medical necessity
- Interprets existing policies and develops new policies based on changes in the healthcare or medical arena.
- Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Supports the Medical Management staff ensuring timely and consistent responses to members and providers.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Serves as a resource and consultant to other areas of the company.
- May chair or serve on company committees.
- May be required to represent Anthem to external entities and/or serve on external committee
MD or DO in MN
At least 5 years of post-residency clinical experience required
Requires current, unrestricted MN license to practice medicine
Current ABMS recognized board certification required
Internal Medicine, Surgery, Pediatrics or OBYN specialties preferred
Previous UM/appeals experience preferred